The majority of clinical manifestations of liver disease are attributable to the consequences of hemodynamic changes characterized by portal hypertension, hyperdynamic circulation, and porto-systemic shunting. The pathophysiology of these hemodynamic changes is complex, but in part is simply explained by increased intrahepatic vascular resistance. Recent introduction of transjugular intrahepatic portosystemic shunt (TIPS) procedure has proven to be a very successful means of relieving portal hypertension, and provided an excellent clinical model that can separate the contributions of intrahepatic vascular resistance alone from other pathophysiologic variables present in liver disease. This study will attempt to correlate hemodynamic, immunologic, nutritional and metabolic consequences of TIPS insertion and should provide insights into pathogenesis of liver disease manifestations and aid in the design of future larger studies.